Cerebrospinal fluid adenosine deaminase levels and adverse neurological outcome in pediatric tuberculous meningitis
ABSTRACT There is a lack of data on the prognostic significance of changes in cerebrospinal fluid (CSF) parameters in tuberculous meningitis. Our objective was to determine whether changes in CSF parameters are associated with poor neurological outcome in tuberculous meningitis.
We conducted a prospective cohort study on children admitted with a diagnosis of tuberculous meningitis to Government General Hospital in Kakinada, India. On admission, CSF parameters including cell count with fraction of lymphocytes and neutrophil leukocytes, glucose, protein, lactic dehydrogenase (LDH), and adenosine deaminase (ADA) levels were measured. We compared levels in children with and without adverse neurological outcome.
A total of 26 children was enrolled over a 2-year period. Ten had an adverse neurological outcome. Six had permanent neurological deficits (four hemiplegia and two cranial nerve palsies), two a hydrocephalus and two died. There was no significant (p>0.05) difference in age, gender and in CSF parameters, including cell count, lymphocyte and neutrophil leukocyte fraction, glucose, protein, and LDH levels between patients with and without adverse neurological outcome. Patients with adverse outcome had with a mean (SD) of 17.1 (3.2) IU/l a significantly higher ADA level than patients without, who had a mean (SD) level of 11.3 (2.7) IU/l (p<0.001, t-test).
Adverse neurological outcome in childhood tuberculous meningitis is associated with increased cerebrospinal fluid adenosine deaminase levels.
- The Journal of Immunology 06/2006; 176(9):5137. DOI:10.4049/jimmunol.176.9.5137 · 5.36 Impact Factor
- The Journal of Immunology 06/2006; 176(9):5136; author reply 5136. DOI:10.4049/jimmunol.176.9.5136 · 5.36 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Introduction: Tuberculous meningitis is a medical emergency that low sensitivity of CSF smear staining and mycobacterial culture make its diagnosis difficult, so there is an urgent need for rapid, accurate and reliable laboratory test. The aim of this study was comparing the sensitivity and specificity of CSF adenosine deaminase (ADA) level with Polymerase Chain Reaction (PCR) test in the diagnosis of tuberculous meningitis (TBM). Methods and Materials: In the period between January 2007 and January 2008 we had 49 patients with primary diagnosis of TBM in Bou-Ali University hospital. After committing and using the definite and probable TB as a golden standard, the final diagnosis for 29 of them was TBM. Results: Our study showed that the sensitivity and specificity of CSF-ADA level in comparison with PCR results in diagnosis of TBM with a 6.5 IU/L cut-off were 100% and 85% respectively. Our study showed that selecting a 6.5 IU/L cut-off with respect to the PCR results of the patients makes a reasonable sensitivity and specificity for CSF-ADA test in TBM diagnosis. Conclusion: Our study emphasized that CSF-ADA level measurement can be used as a good, rapid and reliable laboratory test for diagnosing tuberculous meningitis.Iranian Journal of Child Neurology 01/2010; 8:651-658.